American Society of Plastic Surgeons
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laurenr80
one month ago
Answered

Explant, lift with tummy tuck safety

Hello,

I would like to enbloc capsulectomy explant, lift and get a tummy tuck.

I am 40 years old, pretty healthy..eat very healthy, no smoking, occasional glass of wine, work out..I am a smaller woman (116 lbs 5’3”)..I posted on an explant Facebook site about the surgery and they said a woman died when she combined those surgeries? I’ve been told it’s perfectly safe and I am healthy for it. ???

Procedure: Breast Implant Removal
Type: Question

Replies 7

Debra Johnson
ASPS Surgeon
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Statistics show that combined procedures carry more risk of complications and even death. One large study showed that although plastic surgery carries a low risk of death, many of the deaths involved an abdominoplasty plus another procedure. Combining procedures increases the anesthesia time. Abdominal procedures and prolonged anesthesia do increase the risk of blood clots forming in the legs, with the risk of pulmonary embolism if the clot moves to the lungs. That being said, I do perform combined procedures often, but only on healthy people who promise to drink plenty of fluids after surgery and walk immediately and frequently after surgery. Make sure your doctor uses a sequential compression device on your legs during surgery, and best if they even send you home with the SCD machine to use for a couple of days when you're sleeping. Although touted in chat rooms, there is no science behind en bloc capsulectomy. To perform it requires a larger incision to get to the capsule.

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Debra Johnson
ASPS Surgeon
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This larger incision can disrupt blood supply to the breast, skin, and nipple. The necessary incisions for the lift also disrupt some blood supply. You are therefore increasing your risk for wound healing complications if you insist on en bloc removal of your implant. It would be a safer procedure if you allowed your surgeon to make a smaller incision, open the capsule, remove the implant, and then perform the capsulectomy. And if your implants are submuscular, the posterior capsule can at times be strongly attached to the ribs and very difficult to remove. I tell patients I will remove as much of the capsule as possible, but that I won't risk giving them a pneumothorax (a hole into the chest wall) just to remove the last little bit of capsule, particularly when we can't prove its removal is at all beneficial. Sorry to be Debbie Downer, but you need to know your choices have consequences.

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Sameh Elnoamany
ASPS Int. Surgeon

It is common to combine these two procedures; lipoabdominoplasty with explanation and lifting. Fat injection can be done with lifting to increase breast volume and projection . Of course preoperative preparation is mandatory regarding blood count and liver and kidney functions. Coagulation profile should be done. Prophylactic measures against venous thrombosis should be done. Blood transfusion may be needed.

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Victoria Vastine
ASPS Surgeon

As Dr.Johnson indicates, there are increased risks with combined procedures, and with appropriate planning and precautions the risks can be reduced. En bloc Capsulectomy is sometimes very straightforward, but more often is not indicated and potentially even harmful. There are many factors to consider and discuss, and your best option is to meet with a plastic surgeon that is certified by the American Board of Plastic Surgery and has experience in these types of operations so they can discuss your options. Plastic surgery is a very individualized process, and indications and risks can vary greatly in patients.

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Praful Ramineni
ASPS Surgeon
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Breast surgery combined with abdominal surgery in a healthy patient can be done safely and is commonly combined. Oftentimes, patients will also request that some of the fat harvested during the abdominoplasty (through liposuction) is used for fat grafting to the breasts to replace some of the lost volume from the explant. This combined procedure should be done in the hospital with adequate dvt prophylaxis and can be done safely.

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Nelson Castillo

Thank you for sharing your question. Combining procedures can be done safely, in the right patient population. It also depends on the extent of work entailed and the anticipated length of the procedure. Best to seek out a series of consultations in your area to get the best advice.

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Adolfo Sesto
ASPS Int. Surgeon

Hello. Any plastic surgery procedure carry risk. But when the patient has enough hemglobin levels and a good health, and get a low risk point in the Caprinni scale of risk, is ok to procede with a combination of two procedures, no more. So the answer is yes you can get your procedures perform at one surgical time if your pre ops are good enough.

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